New York State Department of Motor Vehicles -Traffic Violations Division AA-3.3 (9/10) APPLICATION TO REOPEN DEFAULT CONVICTION www.dmv.ny.gov INSTRUCTIONS Only use this application for tickets for which you have been convicted by default. Please read and follow all directions CAREFULLY. Failure to follow directions or failure to provide complete information will delay processing and may result in return or denial of your application. 1. 2. 3. 4. Use a separate application for each ticket. If submitting more than one application, send ALL applications in ONE envelope. You may submit an application to reopen a default conviction only ONCE for each ticket. You MUST provide ALL of the information requested on this form, including completing the statements “I am NOT GUILTY because:” and “I DID NOT RESPOND to the ticket and/or notices because:”. You may continue your explanation on additional 8 1/2” x 11” pages, if necessary. DO NOT WRITE ON THE BACK OF THIS SHEET. 5. You must attach any documents necessary to support your reasons for not responding to the ticket and/or notices. For example, if you failed to respond due to incarceration, a letter from the Correctional Institution, the Parole or Probation Department, or other appropriate agency, on agency letterhead, signed by an authorized agent and verifying complete dates of incarceration, must be included. 6. After completing this application, please read the statement in the box above the shaded portion of the page, then sign and date the application. Mail this completed application and supporting documents to: Traffic Violations Division, P.O. Box 2950 - ESP, Albany, New York 12220-0950 (The form must be mailed; fax copies are not acceptable.) COMPLETE THE INFORMATION REQUESTED BELOW. Please print, and enter your CURRENT mailing address. Name (Last, First, MI) Date of Birth (Month/Day/Year) Client ID No., if available / Street / Apt. No. State City Describe the violation (for example, speeding, driving without insurance, etc.) Date of Violation Ticket No. / Zip Code / I am NOT GUILTY because: I DID NOT RESPOND to the ticket and/or notices because: Read the statement below; sign your name, and write the date you signed this form. I affirm under penalty of perjury that all of the information above and all supporting documents are true, and that no prior application has been made with respect to this ticket. Signature X____________________________________________________________ Date_____________________________ FOR DMV USE ONLY - Do Not Write Below This Line. DENIED REOPENED (Schedule a hearing) FACT: DISMISSED NOT ADJUDICATED DATE: ___________________ Comments: Lack of meritorious defense No/inadequate excuse for default DOCUMENTATION: No/inadequate documentation for excuse RESCIND REVOCATION REDUCE FINE TO $ ____________________ (plus applicable surcharge) ALJ CODE 0 ± Administrative Law Judge American LegalNet, Inc. www.FormsWorkFlow.com